Veteran-Centered Care for Advanced Liver Disease

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This project aims to improve care for Veterans with advanced liver disease by implementing a whole person, Veteran-centered approach. It utilizes a telemedicine-based nurse care counselor to facilitate discussions about illness severity, patient priorities, and care preferences. The study will evaluate the effectiveness of this approach through a randomized controlled trial at four VA centers, focusing on increasing rates of liver transplantation consideration and serious illness discussions. The findings will help refine the intervention and inform its broader implementation.

Why it matters

Who can join: the full rules

Inclusion Criteria:

* Patients will be between 18 and 80 years of age
* Patients must be Veterans
* Patients must have been in care at one of the recruiting sites with 1 or more encounters in primary care or GI/Hepatology in the last 24 months
* Patients must have advanced liver disease, defined by ICD-10 codes for cirrhosis complications (ever) or MELD 3.0 \>12 or MELD-Na \>12 or Fibroscan LSM \>20kpa

Exclusion Criteria:

* Non-Veteran patients
* Patients who do not speak English, do not have access to a telephone or computers, have cognitive impairments, or who are unable to complete a valid informed consent form after three attempts
* Patients who have already made significant progress toward our endpoints: a) with prior history of liver transplantation, or b) on the liver transplant waiting list, or c) had formal evaluation for liver transplantation in the past 3 years
* Patients with very limited life expectancy (advanced cancer, acute-on-chronic liver failure, and hospice patients)
* Patients hospitalized, or in long term facilities or nursing homes at the time they meet inclusion criteria
* Patients with chart diagnosis of uncontrolled mental health or schizophrenia

Where it's running

• Central Arkansas Veterans Healthcare System , Little Rock, AR
  Little Rock, Arkansas, United States Recruiting
• VA Palo Alto Health Care System, Palo Alto, CA
  Palo Alto, California, United States Recruiting
• VA Greater Los Angeles Healthcare System, West Los Angeles, CA
  West Los Angeles, California, United States Recruiting
• Michael E. DeBakey VA Medical Center, Houston, TX
  Houston, Texas, United States Recruiting
• VA Long Beach Healthcare System, Long Beach, CA
  Long Beach, California, United States Not yet recruiting
• VA Connecticut Healthcare System West Haven Campus, West Haven, CT
  West Haven, Connecticut, United States Not yet recruiting

Study contacts

• Principal investigator: Fasiha Kanwal, MD MSHS — Michael E. DeBakey VA Medical Center, Houston, TX
• Study coordinator: Juana Campos, MA
• Email: juana.campos@va.gov

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.